HI-FIVE (Health Informatics For Innovation, Value & Enrichment) Training is a 12-hour online course designed by Columbia University in 2016, with sponsorship from the Office of the National Coordinator for Health Information Technology (ONC). The training is role-based and uses case scenarios. Also, it has additional, optional modules on other topics of interest or relevance. Although we suggest to complete the course within a month's timeframe, the course is self-paced and so you can start and finish the course at anytime during a month's time period. No additional hardware or software are required for this course.
Our nation’s healthcare system is changing at a rapid pace. Transformative health care delivery programs depend heavily on health information technology to improve and coordinate care, maintain patient registries, support patient engagement, develop and sustain data infrastructure necessary for multi-payer value-based payment, and enable analytical capacities to inform decision making and streamline reporting. The accelerated pace of change from new and expanding technology will continue to be a challenge for preparing a skilled workforce so taking this training will help you to stay current in the dynamic landscape of health care.
This course is one of three related courses in the HI-FIVE training program, which has topics on population health, care coordination and interoperability, value-based care, healthcare data analytics, and patient-centered care. Each of the three courses is designed from a different perspective based on various healthcare roles. This first course is from a clinical perspective, geared towards physicians, nurse practitioners, physician assistants, nurses, clinical executives and managers, medical assistants, and other clinical support roles. However, we encourage anyone working in healthcare, health IT, public health, and population health to participate in any of the three trainings.

教学方

Rita Kukafka

脚本

Welcome to value-based quality and safety. This is Lecture C -- Reporting quality performance measures. The objectives for this lecture, reporting quality measures, are to discuss why data transparency and public reporting of quality metrics are important, describe CMS's role in quality performance measurement, discuss the challenges of quality measurement, and describe the value based care strategies of tomorrow. Collecting and publicly reporting data regarding cost and quality of healthcare have grown exponentially in the past decades. Advocates for data transparency say that public reporting helps providers improve by allowing them to benchmark their performance against other providers and encourages insurers to reward quality and efficiency. Furthermore, reporting resource use data on a community basis or a regional basis will hold providers in the area jointly accountable. This is a much fairer way to publicly report than holding physicians solely accountable for episode costs that involve multiple physicians and other levels of care. The new models of care include insurers utilizing bundled payment options, refusing to pay for redundant services or poor quality, and sharing financial risk with healthcare organizations. These changes will force practices to create processes to better manage their finite resources. In order to assure comparability across providers there also needs to be standardization of measures. A variety of standardized measurement tools and surveys are available to providers. HEDIS is a tool used to measure performance by the majority of health plans in the United States. HEDIS collects 71 data measures across 8 domains of care. Because HEDIS is being utilized by more than 90% of the American health plans, benchmarks and comparisons can be made among health plans. CAHPS is a patient experience survey developed by AHRQ, the Agency for Healthcare Research and Quality. It focuses on the patient experience and includes the consumer's assessment of quality, such as the communication skills of their care providers and perceptions about access to healthcare. CAHPS survey results are publicly reported and can be accessed by any individual or organization. The medicare HOS measures patient reported outcomes in the Medicare managed care population. CMS does not create or endorse measures. However, CMS funds initiatives and new models of care to improve quality and reduce healthcare costs. The hospital value-based purchasing program, or VBP, links payment to value in order to improve quality in the inpatient hospital setting. The VBP initiative attempts to reduce inappropriate and unnecessary services and reward high-performing providers. The Hospital Readmission Reduction Program, or HRRP, was introduced as part of the Affordable Care Act, reducing Medicare payments to hospitals with excess readmissions. The hospital-acquired conditions initiative allows CMS to make payment adjustments to qualifying hospitals based on risk-adjusted quality measures. Hospitals who have more patients with hospital-acquired conditions will see reductions in payments. In addition to the well-established CMS initiatives, the Affordable Care Act created a CMS Innovation Center and seeded it with $10 million to be used over ten years to develop new payment and service delivery models, including episode based payment initiatives. Some examples of these initiative include a comprehensive care for joint replacement model and the oncology care model, which focus on specific conditions that are high in cost and frequency. Organizing by a patient's medical condition such as heart disease or renal disease, not by specialty or intervention, is the future of health care. As part of the EHR incentive program under meaningful use, eligible providers and hospitals are required to report on clinical quality measures. Over the years, the clinical quality measures that are required have changed and will continue to change. With each stage of meaningful use, eligible providers and hospitals are required to report on more measures. The CQMs align with the national quality strategy domains and providers must select measures which fall under three of the six categories on the screen. There is also a core set of CQMs for adults and for pediatrics which must be measured and reported in order to meet the requirement. The core set will be updated and published by CMS. The URL on the screen provides more specific information on the 2014 measures. PQRS is is a CMS incentive program that rewards providers for reporting quality measures. Although initially separate from the Meaningful Use quality reporting requirements, PQRS measures and the Meaningful Use quality measures are now aligned. PQRS also penalizes eligible providers who don't report with negative payment adjustments. There are a number of mechanisms for reporting depending on whether providers are reporting as a group or as individuals and which type of data they are using for their measures. The Value-based Payment Modifier uses the PQRS data to determine the incentive or penalty. Providers have the ability to select measures that are relevant to their practice. There are measures that are specific to pediatrics, general medicine, and various specialties. An ophthalmologist can select a measure on glaucoma and diabetic retinopathy. A primary care doctor can select the same measure on diabetic retinopathy and other measures related to diabetes. CMS is trying for further alignment and will allow PQRS to do double duty, so that PQRS reporting will also qualify for the Meaningful Use clinical quality measures and accountable care organization reporting. Most measures including the HEDIS measures are process measures that capture compliance with practice guidelines. Porter and Lee give the following example. We currently monitor cholesterol and hemoglobin C1c levels for diabetic patients. But few providers measure what really matters to the diabetic patient, the ultimate outcome. Like whether the patient loses their vision, has a heart attack, or has to undergo one or multiple amputations. Value-driven health care of the future will encompass how the patient fares on all outcomes that matter. The level of care across setting, and the amount of resources used to treat the patient. Obtaining and using these measure presents a number of challenges. We earlier discussed the challenge of consistent data collection and recommended that, where possible, data be collected in structured form and that providers know how and where to record the relevant data. There may need to be decisions at the local level as to which measures and which data are going to be recorded. This will require input and consensus from clinicians and other leadership. Also, while some vendors will make sure their systems include the relevant data in structured form for mandated reporting, others may not. If they don't, there may have to be special configurations or customization to assure the data are collected. Finally, clinicians and others who are reporting the data need to be educated about the importance of their documentation of care as well as trained on how and where to record it. Collecting data from multiple providers who may not use the same EHR or who may not even use an EHR is another challenge. Many information systems are still not interoperable. That is, they cannot easily exchange information with other systems. Standards for health information exchange are still in the process of being developed but are not yet universally agreed upon. Without common messaging standards it may be difficult to exchange data. And without the use of common terminologies and vocabularies it may be impossible to understand what is exchanged. The office of the national coordinator has a roadmap for interoperability that lays out a plan for full interoperability across disparate systems by 2024. With in a group of providers for instance, in a network of providers, or among the entities in an accountable care organization, efforts at agreement on standards and adherence to national standards when they exist need to be encouraged. CMS, under the new MACRA legislation, is making an effort to align their own incentive and quality reporting programs, to make it easier for providers to meet the criteria. But CMS may not be the only entity with reporting needs. Healthcare providers typically have to report to a variety of entities. In addition to these external reporting needs, there may be internal ones as well that may require different measures from those required externally. Since process can effect outcomes, it is possible that external entities may only be concerned about outcome measures. But for quality improvement purposes, process measures may be needed as well. Aligning these different needs can be challenging. Quality measures for an episode of care are often based on overall outcomes that include care delivered by a range of providers across multiple health care facilities. If care is good and incentives are provided, and especially if care is poor and penalties are applied, it can be a challenge to know how to fairly distribute the incentives and penalties. Similarly, if quality is not optimal, efforts for quality improvement strategies may have to be initiated and feedback provided to the individual physicians. However, it can be difficult to attribute the source of the problems so that these quality improvement efforts can be made. Despite these challenges, there are strategies that can help providers prepare themselves for value-based care. The Affordable Care Act of 2010 included the articulation of a national quality strategy that also required public reporting of quality measures. The measures are reported to CMS and are available on the Hospital Compare website, www.hospitalcompare.hhs.gov. Not all types of hospitals are included, but there is information on most general hospitals who treat Medicare patients. Not only are healthcare consumers able to compare data on the quality measures, but other stakeholders as well have used these reports. These stakeholders include government agencies at all levels, healthcare facilities, health insurance plans, employers, and professional associations. In addition to providing information that will allow patients to make better informed decisions about their health care, ratings such as these are used by CMS to determine reimbursement and focus organizations on improving the overall care that Medicare and by extension, all patients, are receiving across the full spectrum of services. There are four strategies that a report by the American Hospital Association identified to align an organization with value-based care. Strategy one is to align hospitals, physicians and other clinical providers across the continuum of care. Strategy two is to utilize evidence-based practice guidelines when delivering care. The organization should measure utilization variation and identify how many active patients are engaged in the design and improvement of their care. Strategy three is to improve efficiency through productivity and financial management. Organizations need to have an infrastructure in place to measure expenses per episode of care and have strategic and targeted cost reduction and risk management goals. Strategy four is to utilize state of the art information systems. While the majority of providers are now utilizing EHRs, an electronic health record is only the first step. EHRs are optimized to provide access to information about individual patients. For value-based care, it is necessary to have aggregate data from EHRs across individuals and settings. Developing an enterprise data warehouse that can integrate data from all relevant information sources, and is designed to facilitate monitoring and reporting is an important strategy to facilitate value-based care. This concludes Lecture C, Reporting Quality Performance Measures. In this lecture we learned the following, publicly reporting quality metrics inform consumers and hold providers accountable. Value-based care measures must pertain to the patient's health outcomes, care transitions and the resources used to treat the patient.